iHRIS: Tracking Almost Half a Million Health Workers Worldwide

The world needs approximately 4.3 million additional health workers. Africa alone needs 1.4 million more. Having the right number of health workers, however, is not enough. How can countries ensure their health workers are in the right positions to care for their populations, and how can countries plan for future needs?

Picture this: the Ministry of Health asks the registrar at a nursing and midwifery council to provide the number of nurses currently licensed in the country. The council keeps folders of license application forms, sorted only by year. Some forms are missing or are not yet filed. The registrar stops everything and manually goes through the files, calculating the number of nurses available in the country. It takes a month.

But the number is inaccurate. It doesn’t take into account the nurses who migrated to other countries or those who have died or otherwise left the profession. It doesn’t consider the health workers that are double-counted because they registered at one level and then re-registered after obtaining a higher qualification. Even if the number were accurate, the registrar can’t tell where the nurses were trained, what kind of training they received, where they are practicing, or if they’re up-to-date on their license and education requirements—essential information to understand health workforce challenges and start planning to address them.

This is but one example. Similar challenges are faced by health workforce managers and planners at a country’s ministry of health, national and regional hospitals, and district facilities.

Health leaders in 12 countries are now using the iHRIS software (pronounced eye-ris) to track and manage over 475,000 health workers. Before getting iHRIS, most of these countries used manual filing systems, and health workforce data were difficult to access, aggregate, and analyze.

Now, information at the click of a button

iHRIS is free, open source software specifically designed for use by ministries of health, professional health councils, and health facilities to understand and strengthen the health workforce. IntraHealth International, through the USAID global Capacity Project, launched the first iHRIS product in 2007, when IntraHealth recognized the need for accurate and accessible health workforce data at the country level. iHRIS is making the difference between not knowing where to start solving workforce challenges and getting started.

Two years ago in Nigeria, the nursing council used 18 paper registries, some with many volumes, to track information on the country’s qualified nurses and midwives. Now, Nigeria has the largest iHRIS installation with records on over 240,000 qualified health workers. Six years ago in Uganda, the registrar of the nursing and midwives council described aggregating information in their paper-based system as “a nightmare.” Now, Uganda tracks and manages data on over 69,000 health workers in various systems built on iHRIS.

Countries implementing iHRIS can access data for decision-making, including information about health workers’ distribution, age, gender, training, and specialty—all at the click of a button.

Customizable, open source software for health managers

Since 2007, IntraHealth has introduced two additional iHRIS software products and continues to release enhanced versions with new features. Because iHRIS is open source, local developers are free to tailor the system for a country’s specific needs. In fact, each of the countries using iHRIS customized it to match its own health system processes.

IntraHealth supports the core development of iHRIS and its implementation through CapacityPlus and several other USAID-funded projects, but the value of the software is recognized well beyond IntraHealth and USAID’s doors. Other donors and organizations now contribute to the software and support country efforts to deploy and use it effectively. Some countries, such as Togo, have even deployed iHRIS with only a small amount of remote support.

An online community for in-country iHRIS developers and implementers further supports and extends the software. Thanks largely to volunteers, iHRIS has been translated into 13 languages, making the software even more accessible. Four other countries in the Caribbean, Central America, and Asia plan to adopt the software this year. IntraHealth’s efforts also expand the iHRIS community and build local technology capacity through making documentation freely available online, creating a free eLearning course hosted on the HRH Global Resource Center, posting the software code for easy download and translation, and offering short-term “eHealth Fellows” code bounties.

iHRIS installs with several standard reports, such as facility staff lists that can be aggregated and analyzed at the district or country level; breakdowns of the health workforce by cadre, sex, and age; and staff nearing retirement. Users can also create their own customized reports. By routinely producing reports, human resources managers can better understand the current health workforce situation and assess health workforce issues. Human resources managers use the data provided by iHRIS to create informed strategic plans, deploy health professionals in the right positions to meet health care needs, and retain health worker skills and experience in the country.

Supporting individual health workers

Health workers depend on the support of health leaders for access to the education and resources needed, and health workers have a right to equitable access to opportunities for training, promotion, and other benefits. iHRIS will soon enable health workers themselves to collaborate in keeping their own information current and track and plan their career development. An upcoming release of iHRIS enables self-service, allowing health workers to access their records online and submit necessary changes, improving the accuracy of data that could affect their eligibility for benefits or professional opportunities.

iHRIS can also be used to protect the reputation of legitimate, professional health workers—as well as the public—from fraud. Uganda recently launched a mobile directory linked to iHRIS data, allowing the public to confirm a health worker’s credibility while eliminating “quacks” posing as health professionals.

Other countries are leveraging mobile technology to benefit the individual health worker. Tanzania is developing a method for health workers to use their mobile phones to confirm if their paychecks are available, saving precious time wasted en route to city centers only to find their paychecks are delayed (a recurring problem in some areas). Also on the horizon, health workers will soon be able to register and renew their licenses online without traveling to the health professional councils located in capital cities and standing in lines when health workers could be seeing patients instead.

Returning to the original example, a well-maintained iHRIS can produce reports and tally up the number of nurses in a minute rather than a month. Ultimately, however, iHRIS is a tool to support health managers and health workers, reducing the time and resources administrative processes can take away from what matters most: health workers saving lives.